Pain assessment instruments for patients with impaired consciousness: a systematic review

In patients with impaired consciousness, pain self-assessment is impracticable and communication is compromised, therefore challenging assessment by health care professionals. This causes the use of valid and trustful scales to become fundamental. The present study aims to evaluate the clinical potential of the existent scales for the assessment of pain in patients with impaired consciousness. The literature review comprehends the time frame from January of 2005 to June of 2011 based on two search engines and three databases. A total of 654 abstracts and titles were analyzed, 16 papers were selected for a full body revision of which 8 comprise within the present review. Three university archives were visualized and only 1 paper was included herein. Seven distinct assessments of pain scales were identified in patients presenting impaired consciousness. Only one of the scales took into account physiological and behavioral indicators, whereas the remaining others included solely behavioral indicators. The BPS scale obtained the highest rating, thus turning its implementation possible in these patients. More research, concerning the effects of the use of assessment of pain tools in clinics and their implications, is required.